Primary care is as easy to find in HMO-saturated Los Angeles as aspiring screenwriters. But when the Lambda Medical Group opened for business Sept. 28, it represented a breakthrough: gay and lesbian primary care.
Two-physician Lambda is the first primary-care medical group in the nation to cater exclusively to gays and lesbians, according to the Gay and Lesbian Medical Association in San Francisco.
Lambda was opened by the Los Angeles-based Gay and Lesbian Center, which operates an outpatient clinic in Hollywood. Lambda is affiliated with 247-bed USC University Hospital and 762-bed Cedars-Sinai Medical Center, and participates in 14 HMOs.
Sue Rochman, GLMA's director of communications, said: "There are gay and lesbian health centers throughout the country, and there have been great outreach efforts in specific communities. But this is the first time there has been a place where (gays and lesbians) can receive specific primary care."
The need for gay and lesbian primary care is apparently so great that more than 400 potential patients have inquired about Lambda, said Joseph DeFoto, M.D., one of the group's physicians. The day after Lambda opened, its waiting room was full.
"It's been a great start and will allow us to address some of the overlooked problems in the community," said DeFoto, noting that lesbians often skip regular gynecological exams.
Lorri Jean, executive director at the Los Angeles Gay and Lesbian Center, and Rochman said some individual physicians target their practices at gays and lesbians, but most limit their practices to plastic surgery or treatment of AIDS patients. And those physicians often accept only cash or indemnity coverage and participate in few managed-care plans.
According to a 1994 survey of GLMA's physician membership, 67% said they were aware of gay, lesbian or bisexual patients who had received substandard care because of their sexual orientation, while 88% said their fellow physicians had made disparaging remarks about gay, lesbian and bisexual patients.
Such findings reinforce the wariness of many gays and lesbians enrolled in managed-care plans. They worry about receiving primary care from a doctor they don't know, who may be uncomfortable with their sexual orientation.
"Many have experienced bigotry at the hands of ignorant and discriminatory doctors, or they fear they will," said Jean. She recalled that after an automobile accident, her care in an emergency room was delayed by more than an hour because the attending physician abandoned her after Jean revealed her sexual orientation.
A study published in last April's issue of Academic Medicine revealed that of nearly 2,000 physicians surveyed in New Mexico, about 10% said gay and lesbian physicians should be discouraged from practicing in specialties such as obstetrics, pediatrics and urology.
Lambda's 2,400 square-foot-office is located on the ground floor of a commercial high-rise in the Miracle Mile district of Los Angeles, about four miles west of downtown. Most of the other tenants are nonmedical, such as the Screen Actor's Guild and other entertainment-oriented firms.
Jean said her organization conducted a study that showed the neighborhood was underserved. The building was also one of the few in the area with ample parking.
Jean projected that Lambda will treat 1,500 patients in the first year and 4,500 within three years. She anticipates two more physicians joining the practice.
Despite Lambda's openness about treating gays and lesbians, Jean predicted that about 15% of the group's patients would be heterosexual-echoing the numbers treated at the Gay and Lesbian Center's outpatient clinic.
"It's really a welcoming and respectful environment," Jean said.